Alcoholic liver disease: Mechanistic insights and therapeutic potential of traditional Chinese medicine through preclinical and clinical evidence

Abstract

Ethnopharmacological relevance: Alcoholic liver disease (ALD), a chronic liver injury induced by prolonged alcohol consumption, involves intricate multi-organ interactions, such as gut-liver axis disruption, as well as the synergistic effects of multiple factors including oxidative stress, intestinal dysbiosis, and metabolic disturbances. These complex pathological mechanisms render single-target therapies largely ineffective in achieving desirable therapeutic outcomes. Traditional Chinese medicine (TCM), characterized by its multi-target mechanisms and low toxicity, has demonstrated unique advantages in the treatment of ALD in the past decades.

Aim of the study: This article aims to review recent research progress on TCM for ALD treatment, focusing on experimental studies and clinical validation of both single and combined TCM formulations as well as their active components. It seeks to comprehensively analyze the pharmacological mechanisms and therapeutic efficacy of TCM in ALD intervention, highlighting key targets and clinical translational potential.

Materials and methods: To systematically review research progress on TCM for ALD, a comprehensive literature search (covering from 1996 to 2025) was conducted across PubMed, Web of Science, and CNKI databases. Search strategies employed combined subject headings and free-text terms, using core Boolean logic: (ALD-related terms) AND (TCM/herbal medicine-related terms) NOT (Non-alcoholic liver disease). Documents without DOIs and those with suboptimal study designs (e.g., lacking proper controls, inadequate methodological description, absence of herbal quality control, or insufficient mechanistic exploration) were excluded. Eligible studies focusing on TCM compound formulas, single herbs, and active ingredients as primary interventions for ALD were analyzed to provide an integrated foundation for this review. Plant names were verified through the Multilingual Plant Name Server (MPNS, http://mpns.kew.org).

Results: Recent studies demonstrate that TCM interventions effectively address the multifactorial nature of ALD by targeting oxidative stress, restoring gut-liver axis balance, modulating intestinal flora, and correcting metabolic abnormalities. Both single and combined TCM formulations as well as some of their active components have shown promising results in experimental and/or clinical settings, underscoring their multi-target advantages. Despite their potential, significant limitations remain in the current research, necessitating more comprehensive studies on the potent bioactive components, potential pharmacological effects, specific targets, and clinical value.

Conclusion: TCM offers a promising therapeutic strategy for ALD due to its ability to simultaneously target multiple pathological mechanisms. This review highlights the potential of TCM in ALD treatment and provides a foundation for future research and clinical applications, emphasizing the need for further exploration of its pharmacological mechanisms and therapeutic efficacy.

Keywords: Alcoholic liver disease; Gut-liver axis; Intestinal microbiota; Metabolic abnormalities; Multi-target therapy; Oxidative stress; Traditional Chinese medicine.